2型糖尿病Toll样受体4与颈动脉内膜中层厚度的相关性研究  

The correlation between toll like receptor 4 and carotid intima-media thickness in patients with type 2 diabetes

作　　者：吕亚亚 师维雅 左玉琼[3] 何启娟 李永红[4] 周祖邦[5] 许衍甲[2] 权金星[2] 刘静[2] 

机构地区：[1]甘肃中医药大学,兰州730000 [2]甘肃省人民医院内分泌科,甘肃省内分泌代谢病重点实验室 [3]甘肃省人民医院内分泌科,甘肃省内分泌代谢病体检中心 [4]甘肃省人民医院内分泌科,甘肃省内分泌代谢病临床检验中心 [5]甘肃省人民医院内分泌科,甘肃省内分泌代谢病超声诊断科

出　　处：《中华内分泌代谢杂志》2015年第12期1017-1021,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金资助项目（81260136,30960147）;甘肃省自然科学基金资助项目（1010RJZA178）

摘　　要：目的探讨2型糖尿病患者外周血单个核细胞Toll样受体4（TLR4）信号与颈动脉内膜中层厚度（CIMT）的相关性。方法选取本院2型糖尿病住院患者66例，其中2型糖尿病无大血管病变组[CIMT〈0．9mm]20例，2型糖尿病合并大血管病变组（CIMT≥0．9mm或有颈动脉斑块）46例。性别、年龄匹配的健康志愿者40名作为对照组。采用流式细胞术检测外周血单个核细胞TLR4表达水平，测定CIMT、超敏C反应蛋白（hs—CRP）、白细胞介素（IL）-6和单核细胞趋化蛋白1（MCP-1）水平。应用单因素方差分析、Pearson相关分析、多元线性回归分析及logistic回归分析等进行数据分析。结果2型糖尿病合并大血管病变组TLR4表达水平显著高于2型糖尿病无大血管病变组和对照组[（18．60±4．64对14．92±3．47，12．80±2．60），P〈0．05]；2型糖尿病合并大血管病变组IL-6、hs—CRP及MCP-1水平较对照组显著增高I（6．08±3．16对4．52±2．04）pg／ml，（2．67±2．40对1．53±1．49）mg／dl，（307．99±113．39对242．50±48．04）pg／ml，均P〈0．05]，但与2型糖尿病无大血管病变组比较无显著性差异（均P〉0．05）；Pearson相关分析表明：CIMT与TLR4、IL45、hs．CRP、MCP-1、年龄、空腹血糖、HbA，，和稳态模型评估的胰岛素抵抗指数（HOMA—IR）呈正相关（r=0．540、0．244、0．271、0．329、0．381、0．490、0．471、0．410，均P〈0．05），与高密度脂蛋白胆固醇（HDL．C）呈负相关（r=-0．323，P〈0．05）。TLR4与CIMT、HOMA—IR．IL-6、hs．CRP和MCP．1呈正相关（r=0．540、0．428、0．214、0．242、0．385，均P〈0．05），与HDL—C呈负相关（r=-0．384，P〈0．05）。多元线性逐步回归分析显示：TLR4、年龄、空腹血糖是CIMT的独立影响因素（R。=0．292、0．423、0．492，均P〈0．05）。Logistic回归分析显示TLR4水平升高是颈动脉斑块形成的危险因素（OR=1�Objective To investigate the correlation between toll like receptor 4 （ TLR4 ） pathway and carotid intima-media thickness （CIMT） in patients with type 2 diabetes mellitus （T2DM）. Methods A total of 66 patients with T2DM were classified into two groups based on the value of CIMT, T2DM without macrovaseular injury group （ CIMT 〈0.9 ram, 20 subjects） and T2DM with macrovaseular injury group （ CIMT≥0.9 ram, or with plaques, 46 subjects） ,40 gender and age matched healthy subjects were used as the control group. The CIMT, serum levels of high-sensitivity C-reactive protein （hs-CRP） , interleukin-6 （ IL-6 ） , and monocyte chemotactic protein-1 （ MCP-1 ） were tested. The level of TLR4 protein expression on peripheral blood monoeyte cells was detected using flow cytometry. Single-factor analysis of variance, Pearson linear analysis, multivariate linear stepwise regression model, and Logistic regression model were performed to analyze the data. Results The level of TLR4 in T2DM with macrovascular injury group was significantly higher than that in both the T2DM without macrovascular injury group and the control group[ （ 18.60 ± 4.64 vs 14.92 ± 3.47, 12.80 ± 2.60）, all P〈0.05 ]. In addition, the levels of IL-6, hs-CRP, and MCP-1 in T2DM with macrovascular injury group were significantly increased as compared with those in control group [ （ 6.08 ± 3.16 vs 4.52 ± 2.04 ） pg/ml, （ 2.67 ± 2.40 vs 1.53 ± 1.49 ） mg/dl, （ 307.99 ± 113.39 vs 242.50 ± 48.04）pg/ml, respectively all P〈0.05 ] , but there was no significant difference between T2DM with maerovaseular injury group and T2DM without maerovaseular injury group. Pearson linear analysis showed that CIMT was positively correlated with TLR4, IL-6, hs-CRP, MCP-1 levels, age, fasting blood glucose, HbA1c, and homeostasis model assessment for insulin resistance （HOMA-IR） （r = 0. 540, 0. 244, 0. 271, 0. 329, 0. 381, 0.490, 0. 471, 0. 410, respectively, all P〈0. 05 ）, while negatively correlated with the level

关 键 词：糖尿病 2型 TOLL样受体4 动脉粥样硬化 颈动脉内膜中层厚度 

分 类 号：R587.2[医药卫生—内分泌] R543[医药卫生—内科学]